Do You Have Computerized Charting?

  1. Hi,
    I work in PACU,and as part of the OR,which has instituted a program through MacKesson,we are working very rapidly toward computerized charting,and are very close now to going 'live'.

    It has caused a major upheaval for all of us RNs - granted,some of it is likely the response most people have to change of any kind - anxiety/stress about learning something new,doing away with what one is comfortable with,etc - but we do think,and feel in our gut, that implementing this in a fast-paced/high-turnover/Critical Care area like PACU is,at best,going to be mindnumbingly stressful (for instance,the program is NOT interfaced with our moniters,so every vital sign has to be logged in by hand - even those being done Q 3 minutes if the patient is receiving treatment for hypo- or hypertension!!!!!!!!!!!!!!). We think the program sucks,and BIG time. Of course,the RNs USING the program were never consulted before the program was bought by some behind-the-desk staffperson.

    We are meeting soon with our Nurse Manager,complete with a formal letter of concern. It would be extremely helpful to hear the opinions and experiences of my fellow nursing colleagues who are working with computer charting. Has it slowed down your practise significantly? Have there been patient-safety concerns? Did it become something 'second nature' to the nurses,something they're very comfortable with now?

    Thanks muchly!

    Jennifer
    •  
  2. 9 Comments

  3. by   meownsmile
    We use McKesson's charting program. We arent in PACU and as of now our PACU doesnt use it. It is being integrated through other ancillary departments now on a limited basis. But we have been using it for a couple years now on our medical and med/surg floors. You do get used to it.

    I can see how it would be a PIA for PACU when your vitals and assessments are so frequent. It would be good if they could integrate with your monitors so vitals automatically were logged onto your screen, but i dont know that it is even available at this time.
  4. by   koyeh
    When our floor went to computerised charting even the family commented how much time the nurses spent on the computer. Heaven forbid, your patient crashed. Now you don't think about it( year later). Click check the vitals and if there right, hit save. Once you know the system everything flows much smoother. Problem, every upgrade seems to be a downgrade and slows the system.
    Problem: went to chart by exception and where to chart the exception. They just wont let you do a nurses note.
    Computerised charting is here to stay.
  5. by   mysticalwaters1
    I don't have your system or rather 3/4 our hospital has it and integrated other programs with it and about to do computer charting. Currently it's the Maakesson as our drug cabinet and the other areas in the hosptal have something else for drug administration but not charting yet. I'm in the ER and we have computer charting. I LOVE it but it may only be b/c the setup of ER. For instance you just have to type pt's names and info in and on our computer screen people are grouped in they're rooms the nurses, mds, and a comment box to type in in xray and whatever is going on so it's an awesome blueprint for the ED. Also people not fully in the system is a greet desk list so you have name and dx at least of all checking in. We have a map for all different procedures and assessments. A lot is checking off boxes ex in upper ext setup you select color, radial pulse palpable ect and areas to type in extra notes. Now, I am SO happy I took typing in school b/c it has helped tremendously and I really like it a lot. Also the program is web based so it automatically refreshes ever few sec plus the system in general moving in and out of all the different areas you can do it very fast. Our other program on reg floors had several programs into one for vs, labs, drug administration, tests. You kept having to go to the original screen because if you went out of order for ex. clicked labs to test it would kick you out. As a result it took longer to load and was a major pain. The system in the ER is much faster and able to move in and out of different segments without delay. Occasionally there are times when the system is being updated and it's a temporary hold up on nights at times for 15min if that and if every night.

    However, our system is not integrated with the monitoring system for vs and cardiac monitoring which yes is a pain. I never worked in critical areas with paper charting so I don't know if this slows me down. I know if stuff is happening fast, I may write down the vs and time and add it in. Also on our cardiac monitors we can print a trend review of vs and any area on the cardiac strip. Could you do that? I do this a lot and may not put in every vs if I print it all. However sometimes someone may accidently delete it and that could be lost, or the paper runs out and you can end it on the monitor and it's lost. What I've learned is to if I need a set of trends print it out and make sure it prints out before ending anything which is common sense but you do get busy. See it's suppose to print if we select end case but you have to make sure. THIS saves time but I don't know if your system can do that.

    We can scan med lists, ct scan/us reports, and suicide notes into our system which has been great. It doesn't take long and the unit clerk can usually do it. However if you print the chart doesn't print out. And our reg floors in the hospital can't view it unless they have our charting system. This really ticks me off b/c the ED got a program first for computer charting then the rest the hosptal finally moving in the direction but pharmacy didn't agree with the drug administration (which ED doesn't deal with) so this great charting system was chucked to add several other programs into 1 and it's really confusing and not user friendly. I'm happy withour ED system and wish our entire hospital used it. At some point they do plan to integrate the cardiac monitoring into this chart system and have access to every sec of it anytime!!!

    Just what happens if there's a computer glitch and stuff lost.... :O(
  6. by   MadamMermaid
    My mom and I work at the same hospital (she's been a nurse for almost 30yrs, and I'm a aide/student). Our facility went live several months ago. She, and most of the other nurses, were VERY apprehensive about the new charting. In the beginning it took much longer for assessments and everyone was flipping with confusion. Now they've all gotten used to it and no one is discouraged by it. There is always a "power user" around to give support/answer questions. Just ask lots of questions, be confident, go in with an open mind, and it will become part of your routine. Since day one my nursing instructors always remind us that nurses have to be "flexible! flexible!".
  7. by   Altra
    Love, love, love computer charting ... would not take a job where it was not available.

    It would be wonderful if the system were interfaced with the monitors so that vitals were captured automatically, but before now, weren't you having to record them on paper anyway?
  8. by   Marie_LPN, RN
    A few of the disadvantages of OR computerized carting: for lightening short cases like ear tubes, you might have charting left to do, the modem cable keeps the computer tethered to the wall, and the good ol' locks-up-at-the-worst-time problem.

    It gets mixed reviews where i work.
  9. by   Bamarina
    The facility I work at the McKesson system and I hate it it takes more time than paper charting. the only convience i see is that you don't have to try to read someones handwriting.
  10. by   HappyNurse2005
    I work on labor and delivery, i've been there nearly a month. They have computer charting, and they didn't where I came from. I really like it. Our blood pressures/heart rate/pulse ox's are interfaced with the computer charting system (QS, Quantitative Sentinel, something like that) and automatically enters them. I do have to manually enter resps and temp.

    With q15 minute charting on pt's on pitocin or epidurals (which is 99% of them, eventually) its great. Although it does record the fetal monitor strip and contraction monitoring into the computers, we still have to manually enter the time btw ctx, how long and how strong they are. And baby heart rate pattern. True, the computer could do that, but it makes sure that someone is actually reading it by making us enter it.
  11. by   comancheshadow
    I've been a nurse for almost 30 years.... I've learned various computer charting in the past, and it has NEVER been much of a problem... however, the McKesson system has been one of the most confusing and difficult one I've ever seen........ I had a one day class... the only class agency was offered.... and, from that moment on, was expected to know the system inside and out, without any questions...... when, staff were still having trouble, after using it for several months. Frankly, it has created a real problem for me to find work! I have asked if there is another class I could take, since my first class, left out so many details that would have made life much easier. But, I do know this... my handwritten notes, while detailed, did not take up as much time to complete, as this computer does. My patients need me... not the computer, however, it sure seems as if that's the only thing everyone focuses on...not the human being in the bed. In critical care, as I've been working, for my whole career, its vital that you actually can write something down quickly... having to turn on a computer , and get your ID and Password in, waiting for the screens to pop up, sure makes that impossible!!! I think nurses should have been consulted on the need for speed, and simplifying of the whole program. Computer nerd types need not apply, please!! We need quick access, and make it user friendly!!! I am totally frustrated in that I can't even work agency or take a travel assignment to keep my income going without knowing how to do multiple systems.... and, you just cannot learn it without using it for a while.... plus, they make changes for the individual hospitals, and if you aren't aware, then, you are just toast!!! Nobody has time to help you, and many are about as annoyed with the whole thing as the rest of us! I wish there was some cd or online examples for those of us who don't have the regular training that staff get.... I can't even get on staff many places if they think they will have to show you the computer charting... and I graduated in the top 5% of the country on my nursing boards....so, I am sure its not lack of ability to learn that is a problem! I'd love to have a CD if there's one available.... does anyone know if there is one?

close